For the past 10 years, Dr. Joseph and Victoria Schwartz have owned a small endocrinology clinic in Englewood, N.J. Lately, they’ve faced their share of challenges, including some that are a result of Obamacare, the health care reform that faces a crucial repeal vote in the House today.

As small-business owners, health care providers, patients and parents, the Schwartzes have been affected by recent changes from all angles -- and they haven’t liked what they’ve experienced.

Dr. Schwartz is the chief endocrinologist and his wife is his office manager. Over the years, their practice has grown to include two part-time physicians, both a full- and part-time physician’s assistant, and about 10 additional employees, not to mention thousands of patients who’ve come to the clinic to be treated for various hormone-related disorders like diabetes, osteoporosis and thyroid dysfunction. At the same time, their family has grown, too. They’re about to have their sixth child.

For as long as Dr. Schwartz has been in practice, his priority has always been his patients: He’s often treated patients for free who couldn’t afford care, and Mrs. Schwartz says he jokes he’d be OK if some patients had to pay him in chickens or eggs, as they might have had to do in the days of a “town doctor.”

But the Schwartzes’ ability to meet the needs of patients and the financial demands of their business has been tested. For example, insurance plans in New Jersey have changed. The various plans the Schwartzes purchased for themselves and their employees last year are no longer available.

This year, they had to pay 25.5 percent more per employee in insurance premiums -- or about $20,000 more per employee than they paid last year. Many of their patients were forced to change plans, too, which has affected the Schwartzes’ reimbursement rates.

Their staff has had to deal with increasingly uncooperative insurance companies that no longer cover important tests their patients need. And every prescription has seemed to require more paperwork.

“The direction that we’re going is so scary and it detracts from medicine now,” Dr. Schwartz said. “It affects how I practice medicine and where I see the practice going. … When you don’t have confidence in your earning potential for the future, you don’t feel the same confidence to grow and acquire new technology.”

For now, to cope with increasing costs, the Schwartzes have stopped accepting some insurance plans. They’ve also implemented a hiring freeze. Their part-time secretary would like to become full-time, but they can’t justify the salary.

“Right now, we’re just trying to stay afloat and not do anything drastic,” Mrs. Schwartz said.

Their patients have made their own painful decisions to adjust to rising costs. Some have had to switch health care providers because Dr. Schwartz is no longer in their insurance network.

“I’m losing patients that I wanted to keep, that I’ve had relationships with for years,” he said. “For the patients, that means they have to start a relationship with a new physician, starting from scratch.”

But Dr. Schwartz refuses to compromise the quality of care he provides his remaining patients.

“One option would be to see more patients, but we’re trying very hard not to do that,” he said. “We pride ourselves on being a practice that spends a good deal of time with every patient. … We work very hard to give patients the time and attention they need.”

Despite these challenges, Dr. Schwartz still enjoys his job.

“The truth is, I love what I do,” he said. “Do I love 100 percent of what I do? No. But 85 percent I love. I love seeing patients, I love treating them, I love endocrinology, I love that we can make a difference in people’s lives. … The vast majority of what I do is just becoming a lot harder to do.”

Does that mean he’d be happy if one of his six children decided to become a doctor as he did -- and as his father did before him?

“That’s a good question,” he said. “I still in my heart believe that medicine is a noble profession and a wonderful field to go into, but I also feel strongly about having a family and, as medicine changes that ability to really have a solid, consistent income, my reservations are affected by that.”

Mrs. Schwartz doesn’t have to think twice.

“I wouldn’t want them going into medicine because I’m just afraid,” she said. “Medicine isn’t what it used to be. … In [my father-in-law’s] days, basically the doctor had a relationship with the patient. The patient paid the doctor. And nowadays it’s so different. It’s a whole different world.”

Tina Korbe is a staff writer in the Center for Media and Public Policy at The Heritage Foundation.